Total Knee Replacement (TKR) for Knee Arthritis in Bath & Bristol

A total knee replacement (also known as total knee arthroplasty or TKR) is an operation that replaces the worn joint surfaces of the knee with durable metal and plastic components. It is most commonly performed for knee osteoarthritis when pain, stiffness and loss of function are significantly affecting daily life.

Mr Simon Abram, Consultant Specialist Knee Surgeon, provides assessment and total knee replacement care in Bath and Bristol. The aim is long-term pain relief, improved mobility and a return to the activities that matter to you.

What is osteoarthritis (OA)?

Osteoarthritis is a very common condition affecting the joints. In the knee, the smooth lining (articular cartilage) that allows the joint to glide wears down over time. As the cartilage thins, the joint may not move as smoothly, and the bone underneath can become irritated. The knee is one of the most commonly affected large, weight-bearing joints.

What causes knee osteoarthritis?

Knee osteoarthritis usually develops due to a combination of factors rather than one single cause. Risk factors include:

Age: it becomes more common over 40
Sex: it is more common in women than men
Body weight: excess weight increases load through the knee
Previous injury: old ligament, meniscus or cartilage injuries can raise the risk
Family history: there can be a strong genetic tendency

In some people, osteoarthritis develops without a clear trigger–it simply progresses over time.

Symptoms of knee osteoarthritis

The most common symptoms are pain and stiffness. People often notice:

Pain that is worse with activity or towards the end of the day
Stiffness after rest (for example first thing in the morning or after sitting), which eases after a few minutes of moving
Grinding, creaking or crackling sensations when the knee moves
Swelling, puffiness or a feeling of warmth
Reduced walking distance, difficulty on stairs, or loss of confidence in the knee

How knee osteoarthritis is diagnosed

There is no blood test that confirms osteoarthritis. Diagnosis is usually made using your symptoms and the findings on examination.

X-rays

Weight-bearing X-rays are commonly used to confirm the diagnosis and assess severity. Typical findings include:

Narrowing of the joint space (because the cartilage has worn)
Bone spurs (often called osteophytes)

MRI scan (sometimes)

An MRI scan is not always necessary, but it may be helpful in selected situations–for example to assess the meniscus, cartilage, or ligaments, when considering whether a partial knee replacement is a good option for you, or when symptoms and X-rays do not fully match.

Treatment for knee osteoarthritis

Treatment can be divided into non-surgical and surgical options. The first step is usually conservative care, aimed at reducing pain and improving function.

Non-surgical treatments (first-line for most people)

Low-impact exercise to keep the knee moving (for example cycling, swimming, walking)
Physiotherapy to build strength around the knee and improve movement control
Simple pain relief (such as paracetamol) if appropriate
Anti-inflammatory medication (such as ibuprofen or naproxen) if suitable for you
Weight loss if you are overweight–often the single most effective lifestyle change for symptom improvement
Injections (including PRP, steroid, hyaluronic acid, arthrosamid) in selected cases

Mr Simon Abram will usually recommend optimising non-surgical treatment before surgery, unless your symptoms and imaging suggest that surgery is clearly the most appropriate option.

When to consider total knee replacement (TKR)

Total knee replacement is typically considered when:

Your osteoarthritis is advanced and symptoms are no longer well controlled with non-surgical treatments
Pain and stiffness are significantly reducing quality of life
Everyday activities (walking, stairs, work, sleep) are consistently affected

The decision to proceed is ultimately yours, supported by specialist guidance and often with input from family or those close to you. TKR is a major operation and requires committed rehabilitation. The operation aims to relieve arthritis pain, but early recovery includes a different type of discomfort related to the procedure itself. For many people, improvement continues over several months, and it can take up to a year for the knee to fully settle.

Pre-operative planning and preparation

Before surgery, you will usually attend a pre-admission assessment. This is a key part of safe planning for a total knee replacement in Bath or Bristol.

Important information to share

Any medical conditions (for example diabetes, heart problems, previous blood clots)
All medications, especially blood-thinners (for example warfarin or clopidogrel), as these may need to be adjusted before surgery
Any allergies or previous reactions to medications

It is important to inform your surgeon if you become unwell with a cough, cold or infection, or if there are any cuts, ulcers, insect bites, spots or broken skin near the knee before your operation.

Anaesthetic options

Your consultant anaesthetist will explain the most suitable anaesthetic plan for you. You will have either a spinal anaesthetic or general anaesthetic, often combined with a spinal anaesthetic or nerve blocks. Local anaesthetic around the knee is commonly used during surgery to reduce pain during and after the procedure.

The operation: what happens in a total knee replacement?

A total knee replacement usually takes around 1 to 2 hours. A cut is made at the front of the knee. The worn joint surfaces are reshaped using specialised instruments, and the new joint surfaces are fixed in place.

What the new knee is made of

Metal components are commonly made from cobalt-chrome alloys
The spacer/liner between the metal components is made from a strong plastic (polyethylene)
The back of the kneecap may also be resurfaced in some cases, depending on wear and symptoms

The components are typically fixed with bone cement.

Mr Abram will usually close your wound with a dissolving stitch and a wound glue, but rarely will use clips if necessary.

After the operation: hospital care and early recovery

After surgery, the focus is on pain control, safe mobilisation, and reducing the risk of complications.

Blood clot prevention

Foot pumps may be used initially to encourage blood flow
Blood-thinning injections are commonly started the day after surgery and continued for a short course at home

Physiotherapy and mobilisation

You will usually start walking and doing guided exercises soon after surgery. Early mobilisation helps reduce the risk of blood clots and chest infections and supports a smoother recovery.

Length of stay and walking aids

Some patients may be able to go home on the same day as their joint replacement (daycare) but many patients stay in hospital for a 1-2 days. You will usually go home with crutches or walking sticks and use them for a few weeks until you are confident and safe walking independently.

Risks and complications of total knee replacement

Total knee replacement is a well-established operation and serious complications are uncommon. However, complications can occur and may affect recovery and longer-term outcome. Key risks include:

Deep infection: an uncommon but serious complication that may require antibiotics and sometimes further surgery
Blood clots: clots can occur in the calf (DVT) and, more rarely, in the lungs (pulmonary embolus)
Nerve or blood vessel injury: rare, but possible due to important structures behind the knee
Stiffness: the knee commonly feels stiff for weeks; a small proportion of patients may need additional treatment for significant stiffness
Numbness: numb patches around the scar are very common and may improve over time
Wear and loosening: implants can wear over time and may eventually need revision surgery
Persistent pain: a minority of patients (up to 10%) experience ongoing pain despite a technically successful operation
Fracture after a fall: a heavy fall can fracture bone around the implant and may affect fixation

Your personal risk depends on your overall health, medications, previous clot history, weight, and other individual factors. These are discussed in detail during your consultation.

When to seek urgent advice after surgery

Increasing redness, heat, wound leakage, fever or feeling unwell
New calf pain or swelling
Chest pain, shortness of breath, or sudden collapse
A sudden change in knee function or inability to weight-bear

Common questions about total knee replacement

How long does a total knee replacement last?

Implant lifespan varies between individuals. Longevity depends on factors such as activity level, body weight, bone quality, alignment and surgical technique. Many total knee replacements function well for 20+ years, but some people may require further surgery if wear or loosening develops.

Will I need physiotherapy after a total knee replacement?

Yes. Physiotherapy is a core part of recovery and is arranged after your operation. Rehabilitation helps restore movement, strength and confidence.

When can I drive after surgery?

As a general guide, driving is often avoided for around 6 weeks after a right total knee replacement. After a left total knee replacement, some people may return sooner if they drive an automatic car. You should only drive when you can safely control the vehicle and meet insurance requirements.

How long does swelling last?

Swelling can take several months to settle. It is common for the knee to feel warmer than the other side during this period.

How long will I need off work?

This depends on the type of work you do. Office-based roles may return within 6 weeks, while physically demanding jobs often require up to 3 months of recovery.

Can I kneel after a total knee replacement?

Kneeling is possible for some people, but it can remain uncomfortable due to scar sensitivity and limited bend. Confidence, technique and gradual desensitisation can help.

Can I play sport after a total knee replacement?

High-impact activities such as running are usually discouraged after a total knee replacement to reduce the risk of early wear. Many people return to low-impact activities such as walking, swimming, cycling, golf, bowls, and doubles tennis once recovery is established.

Can I be assessed for total knee replacement in Bath or Bristol?

Yes. Mr Simon Abram offers specialist assessment and treatment planning for total knee replacement in Bath and Bristol, including guidance on non-surgical treatments, suitability for surgery, and a clear rehabilitation plan.